MEDICARE: KATELYNN C FITZPATRICK PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363AM0700X	Medical Physician Assistant	PA100025	MA
3	363AM0700X	Medical Physician Assistant	1150656
4	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1467965087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYNN C FITZPATRICK PA

Provider Business Mailing Address
First Line	:	300 1ST AVE
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-2736
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 1ST AVE
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-2736
Country	:	US
Telephone Number	:	804-495-0053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2017
Last Update Date	:	09/10/2024

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